﻿<form class="form-horizontal"  data-bind="jqmsubmit: createRegistration">
  <div class="modal-header">
    <button type="button" class="close" data-dismiss="modal">×</button>
    <h3>Registration details</h3>
  </div>
  <div class="modal-body" data-bind="with: properties">

    <div class="control-group">
      <label class="control-label" for="input01">First name</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input01" data-bind="value: FirstName" required="" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input02">Last name</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input02" data-bind="value: LastName" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-birthday">Birthday</label>
      <div class="controls">
        <input type="date" class="input-xlarge" id="input-birthday" data-bind="value: Birthday" required="" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-tele">Phone</label>
      <div class="controls">
        <input type="tel" class="input-xlarge" id="input-tele" data-bind="value: Phone" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-tele">Email</label>
      <div class="controls">
        <input type="email" class="input-xlarge" id="input-tele" data-bind="value: Email" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-street1">Street Address 1</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input-street1" data-bind="value: Street1" required="" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-street2">Street Address 2</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input-street2" data-bind="value: Street2" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-suburb">Suburb</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input-suburb" data-bind="value: Suburb" required="" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-suburb">State</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input-suburb" data-bind="value: State" required="" />
      </div>
    </div>
    <div class="control-group">
      <label class="control-label" for="input-postcode">Postcode</label>
      <div class="controls">
        <input type="text" class="input-xlarge" id="input-postcode" data-bind="value: Postcode" required="" />
      </div>
    </div>
  </div>
  <div class="modal-footer">
    <a href="#" class="btn" data-dismiss="modal">Close</a>
    <button type="submit" class="btn btn-primary">Save changes</button>
  </div>
</form>